Urinary Cytology of Prostatic Duct Adenocarcinoma – A Clinicopathologic Analysis

Abstract

Objective: To review atypical/positive urine cytology specimens from patients with confirmed prostatic duct adenocarcinoma (PDA), describe the cytomorphologic features and discuss the differential diagnosis. Study Design: A retrospective review of the cytopathology archives of The Johns Hopkins Hospital revealed 14 cases of abnormal urinary cytology in patients with histologically confirmed PDAs. Cytologic material was reviewed; cytomorphologic characteristics were analyzed and correlated with histopathologic features wherever possible. Results: There were 7 patients ranging in age from 52 to 80 years (mean age: 68 years). The clinical presentation included; hematuria, bladder obstruction and perineal mass. The cytomorphologic characteristics were: large crowded sheets and three-dimensional fragments (some with papillary architecture) of columnar epithelium with scant amphophilic cytoplasm, basally placed round to oval nuclei with coarse chromatin and absent or inconspicuous nucleoli. Histologic findings showed papillary and cribriform architecture of columnar cells with crowding, nuclear stratification and overlapping with or without nucleoli. Conclusion: PDAs usually present at an advanced clinical stage and may exfoliate owing to their location in the central prostatic urethra. Differentiating PDA from acinar prostatic adenocarcinoma, urothelial carcinoma and metastatic adenocarcinoma is important due to the differences in patient management. Since prostate-specific antigen values are variable, urine cytology may provide a valuable tool for the early detection of these aggressive lesions.

Ductal adenocarcinoma of the prostate: A systematic review and meta‐analysis of incidence, presentation, prognosis, and management

“…In their large series of 371 DAC cases, Morgan et al support this hypothesis, reporting that ductal histology is associated with a 30% lowering of geometric mean PSA compared to AAC, and a more than two‐fold increased chance of having a PSA < 4 ng/mL, independent of other clinicopathological variables 7 . In lieu of PSA, Sathiamoorthy proposes using cytomorphologic features in urine cytology to diagnose DAC, since DAC usually presents at an advanced stage and may exfoliate owing to its location in the prostatic central urethra 18 . Recently, Lin et al supported this proposal in a small study, demonstrating urine cytology was the first evidence of disease in 4/5 (80%) DAC cases compared to 6/23 (26%) AAC cases 19 …”

Prostatic Ductal Adenocarcinoma with Papillary Features in a Bladder Washing: A Possible Pitfall in Urinary Cytology – Report of One Case

“…There are not so many reports concerning the cytology of prostatic adenocarcinoma in urine/bladder washings [2-10]. Most of the reports concern the cytologic criteria of acinar adenocarcinoma and only few [3, 10] mention PDA, mainly in the differential diagnosis with HGUC. The reported case is peculiar in that it is a cytologically low to intermediate grade adenocarcinoma of periurethral prostatic ducts which, due to its papillary pattern of growth and to the presence of an endothelial core, entered differential diagnosis with urothelial papillary carcinoma.…”

“…In one of these series, [2], most PDAs were cystoscopically described as newly diagnosed periurethral lesions as opposed to acinar adenocarcinomas, in most of which a previous history was already known. In another series [3] consisting of 7 cases, only in one case the cytologic diagnosis was consistent with PDA. Most cases of PDA described in the cytologic literature have a papillary structure (but endothelial cores had not been previously observed) and are formed by tall epithelial cells with varying degrees of nuclear atypia.…”

Other Malignancies Primary and Metastatic and Miscellaneous Lesions

“…Diagnostic value of prostatic AdCa in routine exfoliative cytology is limited because cytologically detected cases of prostatic AdCa are at a clinically advanced stage, and of a high Gleason score [ 29 ]. Hematuria and/or outlet obstruction are often presenting symptoms.…”

“…However prostatic duct AdCa is diffi cult to differentiate from colorectal AdCa [ 29 ] or primary enteric type AdCa of the bladder. Ancillary immunocytochemistry for prostate-specifi c antigen, alpha-methylacyl-coA racemase (AMACR), and ERG immunostaining may be helpful for confi rmative diagnosis [ 28 , 29 ].…”